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2013_0510 (2)CHECK ONE: IRRIGATION DOMESTIC X FIRELINE BACXFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: 6 e' l The baclflow prevention assembly detailed below has been tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle a Pressure Vacuum Breaker Double Check Valve © Atmosphere Vac /uum Breaker T�,fan„fart„rrr %/C /��'r size Model Number Serial Number /j �, ` ;, Located At The above is /cee�rtified to be true. Firm Name y>c //u "L- i / r� �° Certified Testa %/, �� �` ,S Firm Address % l' �t 7 f 7 r Cert. Tester No. /dr �'�� �'es�� Date Gauge # 06 & f// 7 i U Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Check 2nd Check Relief Valve Air Inlet Check Valve Initial Test DC- Closed �` 6 Tight 'd Closed Tight 0 Leaked a7. � ❑ Opened at nsid Opened at osid osid RP -_psid Leaked ❑ Did not Open ❑ Leaked ❑ Repairs and Materials Used Test After DC- Closed Closed Tight ❑ Opened at Opened at _osid Repair Tight ❑ vsid osid RP sid The above is /cee�rtified to be true. Firm Name y>c //u "L- i / r� �° Certified Testa %/, �� �` ,S Firm Address % l' �t 7 f 7 r Cert. Tester No. /dr �'�� �'es�� Date Gauge # 06 & f// 7 i U Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy